Safe for the long haul

If a patient experiences angle-closure glaucoma (ACG) on a long-haul flight, clinical help may be hundreds of miles and many hours away. Unfortunately, delayed treatment of ACG can lead to permanent vision loss.

Even limited research can serve as a prompt for ODs to report cases of ACG—and a reason to educate patients.

This conundrum is the focus of a research report, "Angle-Closure Glaucoma on Long-Haul Flights," published online in JAMA Ophthalmology. In the report, clinicians present three case studies of patients who developed ACG on long-haul flights and who were ultimately treated at institutions in England. The patients all had the common risk factor of hyperopia, and all experienced common symptoms of ACG during the flight, ranging from pain and blurred vision to photophobia.

The authors note additional risk factors: "short axial length, small corneal diameter, large anterior/posterior lenticular diameter, female gender, family history, and certain ethnicities, including Inuit and East Asian." They also note that certain medications, such as the antidepressant citalopram—which one of the three patients was using—are implicated.

"Although we cannot exclude the possibility of coincidence, these cases suggest an increased risk of ACG in susceptible individuals on long-haul flights," the authors write, noting such possible exacerbating factors as sitting upright in low light for long periods. They recommend that practitioners advise patients with risk factors about symptoms, as well as how to properly respond in the case of ACG—including being prepared with medications such as pilocarpine eye drops and acetazolamide tablets.

Glaucoma specialist Michael Chaglasian, O.D., associate professor at the Illinois College of Optometry, notes that a much larger case study series would be needed to establish long-haul flights as a serious risk factor for ACG. However, he says even limited research can serve as a prompt for ODs to report whether they have experienced cases such as this—and a reason to educate patients.

"For farsighted patients over age 65, you might ask them if they are planning to travel long distances," Dr. Chaglasian says. "If so, and if you have identified them as at-risk for angle-closure glaucoma, help them be prepared with appropriate preventive measures."